Tiffany Chen
21W.746 Humanistic Perspectives on Medicine
Hippocratic Oath, Final Draft
2/24/05
The Hippocratic Oath Adapted by Modern Technology and Society
As a responsible medical professional, I swear by my faith and on my honor that…
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I will always hold the health and well-being of my patient as my primary consideration.
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I will treat my patient to the best of my abilities and call for assistance from my
colleagues in the medical community when I am unable to provide sufficient care for my
patient. Likewise, I will help any colleague in need of my abilities.
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I will guide my patient and his family in making well-informed decisions, which I will
respect and follow.
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I will respect my patient and not divulge confidential information told to me, unless
otherwise dictated by law.
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I will not refuse service to or provide a lower quality of healthcare to any patient on the
basis of age, sex, religion, or creed.
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I will never compromise my patient’s health for my own personal gain, financially or
otherwise
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I will honor the scientific and humanistic aspects of the medical tradition.
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I understand that this oath was based on modern practices in medicine and may require
amendment, which I promise to seek approval for when I see a need arise.
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Should I breach this current oath, I may be subject to have my privilege to practice
medicine revoked and receive due punishment as determined in the court of law.
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The Hippocratic Oath represented the high ideals of the Hippocratic tradition of medicine,
which is perhaps the most influential source of ancient medicine on modern Western medicine.
Although medical students in Scotland continued to swear by the Hippocratic Oath as recent as
thirty years ago (Chadwick 9), much of the original oath is cryptic and obsolete when taken in a
modern context. That is not to say that the need for a medical oath is now obsolete. In fact, the
establishment of standard ethics and practices in medicine is perhaps more important in the
modern era, with the advent of very powerful, and thus potentially dangerous, technologies. As a
result, a wide variety of modern oaths such as the 1948 Declaration of Geneva have developed
from the Hippocratic Oath and have been incorporated into medical education worldwide. The
oath presented above represents a modern version which reflects the influence of scientific
advancement and social progress on the practice of medicine. However, like the original
Hippocratic oath, the modern oath still clarifies who the doctor is, establishes a code of conduct
for the doctor, and defines the patient-doctor relationship.
The qualifications for being a doctor are simply the characteristics of intellect, morale,
and compassion. Although Hippocrates and his followers struggled to assert the scientific basis
(tekne) of medicine, there is no doubt now that medicine is a science which requires a certain
level of intellect to be learned. In the past and the present, medicine continues to be a pharmakon,
which gives doctors the ability to greatly influence the life or death of the sick. Thus, doctors
must possess integrity of character and moral upstanding. Finally, compassion is required of
doctors to be able to comfort and care for the sick. These qualifications for a doctor are shared in
the values of both the Hippocratic Oath and the modernized oath.
Other characteristics, such as religion and personal lifestyle, should not be factors in
determining the competency of a doctor. The Hippocratic Oath states that the doctor must swear
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to be “chaste and religious in [his] life and in [his] practice” (Chadwick 67). Furthermore, the
oath-taker swears by ancient gods, goddesses, and deities such as Apollo, Aesculapius, and
Health, among others (Chadwick 67). In the context of ancient Greek society, the incorporation
of religion into the practice of medicine was logical, since all the recognized citizens of the
homogenous society were assumed to be religious and of the same religion. Today, however,
such a reference to specific gods, goddesses, and deities, would exclude every one of all other
faiths, in addition to atheists. The role of religion in the lives of physicians, and of anyone else, is
to establish a code of moral conduct. The teachings of Jesus Christ, Buddha, Abraham, and
Muhammad (among other religious figures) all guide believers to live the way of their God, or
Gods. The fundamental value of life, which is a principle that guides most medical decisions, is
shared among all faiths and by the atheist and agnostic as well. A Muslim doctor would give the
same insulin shot to a patient in diabetic shock that a Christian, Jewish, Buddhist, or atheist
doctor would. Based on the evolution of religion, the modern oath omits the reference to gods
but instead refers to a faith, which can be interpreted to mean either a religion or a set of personal
beliefs.
Personal lifestyle of doctors does not reflect the ability to practice medicine, as long as it
does not permeate into the professional life. The modern oath is in accord with the Hippocratic
Oath about chastity in the doctor’s “practice,” meaning his professional life, but disagrees about
its necessity in his “life,” meaning his private life. Although doctors must possess a high
standard of character, they are human and have personal lives. Like any other patient, the doctor
himself has a right to make certain autonomous decisions for himself. Thus, a doctor who
smokes is not a hypocrite. He is fully aware of the consequences of his actions, probably more so
than the average person. His personal decision to smoke does not influence his profession as a
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doctor, as long as his smoking habits are kept private. Since the medical profession is much more
established today, separation between professional and personal lives is more easily
accomplished by doctors today than it was by doctors of ancient Greece. For instance, hospitals,
instead of personal homes, serve as an institution where doctors and patients interact. Therefore,
the requirement of a doctor’s “chastity” in his personal life is irrelevant and does not appear in
the modern oath.
Besides characterizing the doctor as an individual, both the past and present medical
oaths also define the medical community, in terms of its role in medical education and in relating
doctors to each other. Today, practical experience is as fundamental to medical education as it
was in Hippocrates’ time, but the development of sophisticated public healthcare and medical
education systems has redefined the relationships among doctors and their relationships to
doctors-in-training. In “Tradition in Medicine” of the Hippocratic Writings, it is asserted that
medicine is a practical science, or tekne, in which “the facts are unknown to none and with which
all are acquainted by necessity and experience” (Chadwick 72). As such, the Hippocratic Oath
requires doctors to swear to undertake apprentices “without fee or contract” and defines the
medical community as a brotherhood in which the Science (of medicine) is the master, all
doctors are brothers, and pupils are sons (Chadwick 67). This belief in the importance of practice
in learning medicine is reflected in the current medical education program, perhaps the most
rigorous of any profession. After four years of medical school, there is an average of three years
of residency to be completed, plus a fellowship for sub-specialists. During residency and even
clinical rotations in medical school, the student works closely with practicing physicians to gain
practical knowledge in the profession. Only after such training and board certification can one
practice medicine. The establishment of medical schools and hospitals since Hippocrates’ time
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has shifted the responsibility of providing such education to entire institutions from individual
doctors. Although many do choose to practice in a teaching hospital, other physicians practice in
private clinics or other hospitals. As a result, a personal oath that all individual doctors must
undertake should not address medical education, which should instead be addressed by
specifically the faculty and staff of medical schools.
Similarly, the development of hospitals and the specialization of the medical field have
changed the relationships between doctors. Patients today seldom see only one doctor, but rather
a team of healthcare professionals. Every doctor specializes in one of numerous specialties, from
radiology to neurology to pathology. Although each doctor may be knowledgeable about his
particular specialty, his knowledge outside of that specialty may be limited. Even within his own
specialty, he may not be aware of certain new procedures developed by technological advances.
Thus, doctors should realize the importance of the medical community as a resource for fostering
collaboration and education beyond formal training. Included in the modern medical oath should
be a promise to rely on the community when needed and to help colleagues in need.
As a team of intelligent, moral, and compassionate individuals, doctors serve the public
by using science to treat illness and by caring for the sick. Medical science builds on previous
knowledge (Chadwick 71), so that modern practices in medicine always develop from traditional
practices. For doctors, this means what has been discovered and practiced in the past should be
respected. Even though Hippocratic doctors lived nearly 2500 years ago, their traditions have
significantly influenced doctors today. For instance, it was they who discovered the cognitive
function of the brain (Chadwick 248). Thus, the importance of observing scientific traditions
when treating disease is included in the modern oath for physicians.
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Despite tradition, scientific advancement continually raises questions on ethics of new
methods or procedures, such as stem cell research, cloning, in vitro fertilization, or gene therapy.
This ethical controversy prevents such methods from being addressed in an all-encompassing
modern medical oath. One of the most striking aspects of the Hippocratic Oath is its explicit
position on specific medical procedures, which are controversial even today. The oath prohibits
the administration of a “fatal draught to anyone if I am asked” and giving the “means to procure
an abortion” (Chadwick 67). This ancient oath already addresses the complex issues of
euthanasia and abortion. Even the use of surgery is prohibited by the Hippocratic Oath. Today,
surgery is an integral part of the study of medicine and has been established as a traditional way
to treat many conditions, such as heart attacks. Although there are laws restricting or allowing
controversial procedures, every doctor has a unique stance on each issue based on his individual
set of ethics. Even if the doctor has an extreme position on euthanasia or abortion, decisions are
usually made on a case-by-case basis. Thus, the appearance of such explicit positions on
controversial procedures is largely opinion and should not appear in an oath to be taken by
physicians of varying moral standards.
In addition to treating disease, doctors are responsible for patient care, which was
emphasized in Hippocratic medicine but even more so in modern medicine. The growing focus
on patient care today stems not only from a humanistic tradition but also from changing times.
Although the Hippocratic tradition was well-known for its focus on treating patients, the
Hippocratic Corpus does refer to when a patient should be refused treatment. According to the
Science of Medicine treatise, one should “refuse to undertake to cure cases in which disease has
won mastery, knowing everything is not possible to medicine” (Chadwick 140). It continues to
be true that medicine is a complicated and inexact science. In modern medical practice, palliative
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care has emerged as a means of treating the terminally ill, instead of simple refusal of treatment.
Science and technology have improved the quality of life such that people live longer and die
slower. Slower deaths resulting from diseases like “emphysema, diabetes, cardiomyopathy,
cancer, and coronary artery disease” is now much more common than the “sudden-onset”
diseases like pneumonia and cholera that afflicted the pre-World War II era (Pence 64). As a
result, over 80% of Americans die in hospitals (Pence 64). As compassionate individuals, doctors
should comfort these patients in their last moments of life. Thus, the modernized medical oath
reflects this ideal by stating that the health and the general well-being of a patient should be the
doctor’s primary consideration.
Patient care benefits from interpersonal communication between doctors and patients in
order to establish a solid relationship founded on trust. The Hippocratic Oath set practices like
patient confidentiality to develop patient-doctor relationships, but the modern oath extends these
practices to include medical decisions. A growing emphasis on good relationships between
doctors and patients is evidenced by the recent trend of incorporating tests of bedside manner
into medical education (Mckenzie). Bedside manner in itself is not enough to gain the trust of
patients. The doctor needs to guarantee confidentiality of certain information that the patient may
be hesitant to divulge but which may be critical to their treatment. As mentioned in the
Hippocratic oath, “Whatever I see or hear…which ought not be divulged, I will keep secret and
tell no one” (Chadwick 67). Today, the basic concept of patient confidentiality, or medical
privilege, holds true, but can be overridden by the law. Healthcare is no longer strictly a private
practice but is much more public and should be regulated by the government. For instance,
doctors in the emergency room may treat patients who were injured by criminal acts and may be
withholding information pertinent to the criminal investigation. A trusting relationship also plays
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a role in the medical decisions concerning what kind of treatment a patient should undergo. Such
decisions can be complicated because of the issue of who has authority over the decision: the
doctor, the patient, or the patient’s family. The doctor may know the best methods by which to
combat the disease, but the patient may know what best suits his personal needs. However, the
patient’s judgment may be compromised when in a state of sickness and/or pain (Chadwick 142).
Thus, the family may be able to determine what is best. The Hippocratic Oath does not explicitly
address this issue, but it implies that the patient or patient’s family (whoever is in charge of the
household) makes the final decision because of the house-call system. The modern oath agrees
with a certain level of autonomy on the patient’s behalf but, unlike the Hippocratic Oath,
explicitly states this belief, since medical practice occurs in hospitals and clinics nowadays.
Where the trusting relationship is crucial is in a) ensuring that the patient trusts the doctor’s
objective judgment of how best to treat the disease and b) ensuring that the doctor trusts the
patient (and the family) in knowing what is best for them.
The medical oath serves as an authority on key aspects of medical practice relating to the
identity of doctors, their role in treating illness, and their connection with patients, so any
infringement of the oath ought to be addressed in the court of law. Public healthcare, as a societal
issue, is closely related to public policy. The government, at the various jurisdiction levels, has
the authority on the welfare of its constituents, in terms of their health and otherwise. Thus, a
code of conduct as defined by a universal medical oath for doctors should be supported by
enforced laws. Likewise, deviations from the all-encompassing oath should be treated as
infringements of law. In ancient Greek society, “ill-repute [was] the only punishment and this
[did] little harm to the quacks who [were] compounded of nothing else” (Chadwick 68).
However, today the infrastructure of the healthcare system is immensely complex. No longer are
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doctors just individual healers making house calls, but rather, they are part of a community of
healthcare professionals dedicated to (and responsible for) the treatment and care of the public.
Malpractice cases should be tried in the court of law and punishment should be determined by
law. The modern oath suggests the intervention of law in malpractice cases, instead of mere loss
of repute.
Yet, society and technology are continually evolving (as it has during the 2300 years
from ancient Greece to modern America), so a medical oath must have the foresight and
flexibility to allow for amendments to the oath in order to be well-enforced. Because of the
dependence of the medical community on such an oath, any amendments deemed necessary must
be clearly justified and widely agreed upon. Adapting the Hippocratic Oath from its ancient
Greek context to a modern context involves consideration of how technological and social
progress has impacted medicine in terms of the identity of doctors, their role, and their
relationship with patients. No matter what the future of medicine brings, scientifically or
humanistically, we the public can be assured that a medical oath will set universal standards for
the provision of healthcare.
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References:
Chadwick, J. and W. N. Mann (ed.). Hippocratic Writings. London, UK: Penguin Classics, 1978.
Pence, G. E. Classic Cases in Medical Ethics. New York, NY: McGraw-Hill, 2004.
Mckenzie, J. “Med Students Face Bedside Manner Test.” ABC News, 2004 June 14. Available:
http://abcnews.go.com/WNT/MedicineCuttingEdge/story?id=131719&page=1
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